Provider Demographics
NPI:1518258029
Name:DEAN, DIANE (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10100 E SHANNON WOODS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4104
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:10100 E SHANNON WOODS ST STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4104
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:162-195-8993
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2020-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS53-77056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily